Search

IntroductionThe National Comprehensive Cancer Network (NCCN) and the Japanese guideline for treatment of endometrial cancer recommend using hormonal therapy in relapsed cases if hormone receptor status (estrogen receptor/progesterone receptor) is positive.MethodsWe administered medroxyprogesterone acetate (MPA), 200 mg or 400 mg/day, as maintenance hormone therapy following chemotherapy in several patients with recurrent or advanced endometrial cancer.ResultsThe first patient with stage IIIC (pT2N1M0) moderately-differentiated endometrioid carcinoma of the uterine corpus underwent initial operation and postoperative chemotherapy (paclitaxel plus carboplatin for six cycles). After 2 years, multiple lung metastases were found. The patient achieved clinical complete response (cCR) after second- (pirarubicin plus carboplatin for six cycles) and third-line (docetaxel plus carboplatin for six cycles) chemotherapies followed by MPA maintenance therapy (200 mg/day) and has been disease-free for over 4 years. The second patient with stage II moderately-differentiated endometrioid carcinoma of the uterine corpus developed multiple lung metastases 29 months after initial operation. Subsequent chemotherapy (paclitaxel plus carboplatin for eight cycles) resulted in cCR. Thereafter, MPA (400 mg/day) was orally administered as maintenance therapy. She has been disease-free for over 2 years. The hormone receptor status in both cases was positive, and no serious adverse events were observed in either patient. Presentation of other two patients was also added.ConclusionMPA maintenance therapy should be considered after chemotherapy to treat recurrent endometrial cancer in cases with positive hormone receptor status.

Uterine myxoid leiomyosarcoma (MLMS) is an extremely rare variant of uterine leiomyosarcoma; only 56 cases were reported from 1982 to 2013. Uterine MLMS is characterized by a myxoid appearance and highly malignant behavior. We herein report a case involving a 65-year-old woman with uterine MLMS with a large tumor embolism that reached the right atrium. A total abdominal hysterectomy, bilateral salpingooophorectomy, and tumor embolism resection with the use of a heart-lung machine were performed. Epirubicin-ifosfamide chemotherapy in the adjuvant setting led to reductions in both the tumor emboli and peritoneal dissemination. The patient retained a good quality of life for 10 months after the initial surgery. She then developed progressive disease despite treatment with pazopanib. She died of her disease 14 months after the initial surgery. Although complete surgical resection of the tumor is desirable, tumor reduction surgery followed by adjuvant chemotherapy might help to retain a good quality of life. This is the first reported case of a primary uterine MLMS with tumor emboli.